Client Health Safety Survey
Please fill out this survey honestly and on the day of your appointment. Your service provider will review the survey and ensure she is able to perform your service.
Enter full name here
Who is your Service Provider?
Please check the box if you are experiencing:
Fever (100.4 F or higher), or are feeling feverish?
A new cough
Shortness of breath?
New muscle aches?
New loss of smell or taste?
None of the Above?
Are you currently waiting on COVID-19 test results?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service